Fighting Malaria with Financing: Does the Global Fund's AMFm model work?

By Jessica Brinton and Frederick Wekesah

This week as we continue to celebrate World Malaria Day and the (great) progress in the fight against malaria, we also must take this time to remember the deadly challenge that remains: preventing an estimated 200 million illnesses and 600,000 deaths per year -- mostly children under the age of five and most of them in sub-Saharan Africa.

Meanwhile the fight against malaria in Africa is at a critical moment— since many countries that have traditionally funded anti-malaria interventions are now facing major budget cuts. Although the WHO has reported in its 2011 report that malaria-related death rates have dropped by 33% in Africa since 2000 and even heavily affected countries like Uganda have reported large decreases in malaria rates; other countries like the Congo—where malaria rates have more than doubled in the last two years—have seen huge increases in illnesses and deaths from malaria.

Thankfully, even in these times of budget austerity many organizations have remained dedicated to fighting the deadly disease and have recognized that financial and technical assistance cannot waiver if we are to eradicate this physically and economically debilitating illness. From simple but effective public fundraising campaigns like Nothing but Nets and Roll Back Malaria, to The Global Fund, people are working to prevent and treat the disease and ultimately save lives.

One initiative from the Global Fund is using innovative financing to make malaria treatment more available and affordable in highly endemic regions in Africa and especially rural remote areas in Ghana, Kenya, Niger, Mainland Tanzania, Zanzibar, Uganda, Madagascar and Nigeria. These 9 identified countries usually have the worst indicators of access to health care. Called The Global Fund’s Affordable Medicines Facility for Malaria (AMFm), the program is a financing mechanism developed to get the most effective single dose treatment for malaria called artemisinin-based combination therapies (ACTs) to more people who are affected by the disease.

How AMFm works: The Global Fund and its partners and funders have worked with drug manufacturers to decrease the overall price of ACTs, and ensure that sales prices are the same for both public and private sector buyers of the drugs. This is important because if a private buyer pays more to purchase the drugs from the manufacturers that buyer will most likely turn around and sell the drug for more, therefore making the drug unaffordable for many people trying to purchase the treatment.

The Global Fund reports that as a result of the program, today private importers pay up to 80 % less than they did in 2008-2009. The reason the drug manufacturers agreed to this process is because The Global Fund covers most of the reduced price by paying it directly to manufacturers. As a result, the first-line buyers pay only the remainder so patients are able to purchase ACTs from many locations (public, private, NGOs) at lower prices. In Kenya, the ACTs are available at public outlets such as health centers and pharmacies at minimal cost to patients treated in these facilities.

Where APHRC comes in: Last year APHRC was sub-contracted by Population Services International Kenya on behalf of  the AMFm Independent Evaluators (IE) to conduct the  endline survey. This survey will help answer the question of whether the program was effective in at least increasing access to the malaria treatment at a more affordable and subsidized price. APHRC was also sub-contracted this year by the IE to conduct a similar survey in areas of Kenya classified as remote because remote areas are also. 

Both studies used quantitative methods and relied on data from the baseline survey to collect data for the endline and remote areas outlet surveys. The study looked at both the amount of co-paid (price reduced) ACTs purchased or received at the outlet (which is any place, store or center that has the potential to stock anti-malarials) measured by the proportion of outlets in these locations that had co-paid ACTs in stock at the time of the researchers visit.

At the population level, the study measured the amount of co-paid ACTs sold or distributed in the last week before the survey was taken, as a proportion of the total volume of all anti-malarials sold or distributed in the last week before the survey via outlets located in the study locations. Because of the cost and need of the drugs the study assumes that anti-malarials that are sold or distributed are ultimately used by people.

So what did we find? Right now the data is being analyzed and the report being written by the IE, so stay tuned for the results of this innovative new Global Fund program. If it is successful, this model could be another key tool in the war on malaria toolkit and coupled with preventive efforts could mean more lives saved.

To be continued...